Nature negotiations: sharing responsibility for global health
Authors: Liz Willetts
Journal: The Lancet Planetary Health (2022)

As the global biodiversity policy cycle heats up, this policy explainer distils some key issues and debates relevant for global health As the world strives to recover from a pandemic and the global economic ramifications caused by a single pathogen, it is worth pausing to re-examine, and more broadly understand, the global decision-making structure that exists to govern our relationship to all species—to nature and its biodiversity. In 2022, governments will decide how, or if, health is linked to a suite of global biodiversity goals for 2050. This policy primer introduces and distils some relevant debates. The UN Convention on Biological Diversity (CBD) is a multilateral treaty that protects “diversity within species, between species, and of ecosystems.” It convenes an intergovernmental forum whose work broadly addresses the environmental determinants of health and whose decisions affect whether policies conserve and/or sustainably use these determinants. The CBD's 2022 agenda offers the opportunity to strengthen the global focus on pollution, food systems, and urban green and blue spaces, as well as the opportunity to comprehensively elevate biodiversity-human health linkages in the form of a global target, and possibly, an action plan. Following a series of intense intersessional meetings, the CBD will host its bi-annual decision-making forum—the 15th Conference of the Parties (COP 15)—later this year. COP 15 outcomes will impact, and could be used to reinforce, a number of global health objectives. Biodiversity is not a common term in health circles, but interlinkages between the two are “extremely multifaceted”, says David Cooper, a veteran executive in the CBD's leadership. Findings in science and diverse knowledge systems show how intact ecosystems underpin healthy functioning of every physiologic system and mental health. “It's the diversity that is the most protective”, says Cooper, meaning that healthy people depend on the variability of species as well as variability of the interconnections between species and ecosystems. For example, interdependent relationships between diverse species impact pollination and food production or balance of an intestinal microbiome. Fractured ecosystems impair safeguards for health and wellbeing of all species, says Cooper, “We need the health community to see this”. But changing advocacy for biodiversity conservation from an act of altruism to an act of necessity is a significant shift. Aaron Bernstein, director of the Center for Climate, Health, and the Global Environment at Harvard T H Chan School of Public Health (Harvard Chan C-CHANGE), says he was trained as a physician during a time when “many people in health and human medicine had no comprehension that nature mattered at all”. He calls this a “foundational fault line upon which Western institutions [such as medicine] developed and spread, including through colonialism”. Work to scope nature-health interconnections for governments has been building under the CBD for over 20 years. While capturing connections at this nexus requires a wide lens, since the COVID-19 pandemic there has been a tendency to “zoom in on pathogens”, says Cooper. In 2016 and 2018, the CBD's 196 parties agreed to progressive decisions that viewed the biodiversity-health nexus as a landscape. The next intergovernmental move, anticipated for COP 15 (an event originally scheduled for 2020) was global agreement on a granular plan of action on biodiversity and health. Among other aspects, the draft plan outlines more than 20 priority environmental issues affecting health of humans, animals, plants, and other organisms. It also lists specific actions across food and infrastructure sectors and proposes using environmental burden of disease per year as an indicator of its success. It is novel in many ways, including by creating a home for important issues that traditionally fall below the radar, like pharmaceutical pollution, neurotoxicants, antimicrobial resistance hotspots, and biodiversity and mental health. Paradoxically, a narrow focus on infectious disease among governments in 2022 may hinder biodiversity negotiations that intended to strengthen health fields more broadly. Whereas the original approach to health for COP 15 emphasised multi-sectoral action to tackle drivers of ill health, with zoonoses as one of many elements, current debate in the negotiations centres largely on pathogens, with a response to them receiving considerably more attention than addressing root causes, such as land use change. Following CBD intersessional deliberations in March 2022, outcomes on biodiversity-health negotiations are uncertain. The action plan, which now is reflected in a placeholder decision (Recommendation 24/7), appears more likely to be postponed than advanced. At the same time, after 4 years of debate, views to define global biodiversity ambition targets for the period 2020–50 (the post-2020 global biodiversity framework) are still mixed and have yet to include health or reduction of environmental burden of disease. A new, tentative proposal to adopt non-specific sector-level ambition “to produce gains for biodiversity and human health and well-being”, has yet to be discussed by parties. This lack of certainty for intergovernmental progress on the biodiversity-health nexus is surprising given the substantive political foundation established under the CBD and the surge of political momentum rising out of the pandemic to link health and environmental issues. Cooper describes “the inertia of siloes” as an obstacle to interdisciplinary governance. Narrow mandates and funding streams can “lock interdisciplinary thinking out of decision-making”, observes Bernstein, a US paediatrician. “We are limited within the organizations that touch the [biodiversity-health nexus]”, he says, “Donors need to change”. There is also the challenge of deciding who initiates the multi-sectoral governance that a nexus approach requires. Negotiators must adopt responsibilities to be shared by other ministries. Martha Mphatso Kalemba, a biodiversity negotiator for Malawi, notes the importance of health sector “buy-in” to support CBD decisions and their implementation at the national level. Conceptual divides and rigid frameworks might explain why much of the investment of the health community in pandemic preparedness and response has arisen independently through new global health structures. Forums, expert panels, and working groups discuss zoonoses without significant involvement of the biodiversity governance community, which has decades of experience managing zoonotic drivers, including land use, livestock, and wildlife trade. In some cases, at the national level, representatives to separate global health and biodiversity forums may not yet have protocols to share information on similar issues. Siloed policy infrastructures inevitably intersect but, without interdisciplinary building blocks, can produce friction. A crucial element contributing to the separation of biodiversity-health governance in the case of pathogens is that the mandates of the CBD and the World Health Assembly (WHA) collide rather than merge in the case of pandemics. As a result, some in the health sector see the CBD as an obstacle to, rather than supportive of, WHA objectives. The WHA's objective to rapidly share pathogens and their genetic details during health emergencies is an ideal medical response. But, unless specific provisions are put in place, this objective can deprioritise agreement under the CBD to ensure that when certain biological resources are shared across borders, the benefits accrued by the recipient nation are equitably distributed to the nation of source. Following agreement under the WHA in December 2021 to develop a new international law instrument for governing pandemics, the biodiversity community produced a counter-response. Mphatso, representing Malawi, and on behalf of Africa, led a resolution on biodiversity and health adopted under the UN Environment Assembly (UNEA) in March 2022. She notes that the UNEA resolution was partly driven by the need “to foster cooperation in the context of pandemic preparedness, prevention, response and capacity in surveillance” and, she notes, “how to apply these in different national contexts”. She calls the siloed governance problem balancing the “benefits that health gets from biodiversity with what health can do for biodiversity”. The equity of sharing biological resources, known under the CBD as access and benefit sharing (ABS), is not oppositional to global health. But the sour history of biological extraction from biodiversity-rich countries (“biopiracy”) leads some parties to insist that ABS protocols on zoonoses precede emergency response. Those with this view highlight that the processing, analysing, and commoditising of nature is disproportionately done in developed country institutions who, subsequently, will also disproportionately gain from building scientific capacity and from its products, such as treatments or vaccines. Moreover, some developing countries reference the exclusion of Indonesia in a patent for avian influenza virus in 2006 as a meaningful precedent for global response. These countries insist that future international instruments on pathogen-sharing do not undermine equity. Discussions on ABS, and one of its contentious sub-components—the sharing of “digital sequence data” (eg, genetic sequences)—are notoriously thorny aspects of CBD negotiations. Even ABS supporters are uncertain how the complicated legal and financial arrangements of ABS could be practically implemented. Some lament how focusing heavily on this topic via pathogen-sharing in the intersessionals is one reason why little time remained to agree to broader decisions on biodiversity and health. Ironically, if agreed, an action plan or global target on biodiversity and health could create opportunity to address other aspects of health equity—like health outcomes linked to the disproportionate environmental degradation experienced by poor communities worldwide. Unifying interdisciplinary experts within the biodiversity-health field is essential. While systems-thinking in Ecohealth, planetary health, and One health evolve into, as Bernstein says, “the same conclusion” regarding interconnection of all species, an unfortunate turf war between their terms generates unnecessary confusion and distraction to those external to this field, including delegates. Long-standing UN forums on climate change, biodiversity, pollution, and food systems—historically attended by non-health experts—need a common language to communicate health issues in their decision-making processes. Moreover, “whole of government, whole of society” approaches are important and a priority for 2022, says Cooper, “to have good health you need to engage all sectors”. Harmonising the approaches of these three nexus communities is a way to achieve these. COP 15 could move the dial on addressing the environmental determinants of health, identifying future cross-sector health threats, and preventing chronic diseases from environmental degradation and biodiversity loss. But will a narrowed policy focus hamstring a healthy planet and healthy people? There is a role for the health stakeholder community to help “get it right”, says Cooper. This is an essential time for the health stakeholder community to engage and build bridges for meaningful decision on health under the CBD, in 2022 and beyond. The 4th and final meeting on the CBD's post-2020 global biodiversity framework convenes June 21–26 in Nairobi, Kenya. https://www.cbd.int/conferences/post2020/wg2020-04/documentsCBD COP 15 will take place in 3rd quarter 2022; dates and location are to-be-confirmed due to pandemic concerns. The 4th and final meeting on the CBD's post-2020 global biodiversity framework convenes June 21–26 in Nairobi, Kenya. https://www.cbd.int/conferences/post2020/wg2020-04/documents CBD COP 15 will take place in 3rd quarter 2022; dates and location are to-be-confirmed due to pandemic concerns.